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size photographs of her whole family that she had to
have specially taken. Prospective parents often tell
the clinic that they would like to choose a surrogate
on the basis of religion, diet, skin color and age.
On Feb. 29, 2020, she delivered a child through a
C-section. She was 33 at the time and says she chose
the surgery because it took less time than a vaginal de-
livery, and she believed it might be safer for a woman
of her age. “There are some surrogates here who have
a normal delivery, but it is rare,” Parmar says. “Some
surrogates insist on it; then the hospital does it.” She
met the intended parents for the first time the day she
gave birth, and appreciated that they took a picture
while she held the baby girl. Fifteen days later, she
went home. “I am giving a couple that cannot have
the opportunity to have a baby a child, and in re-
turn, they are giving me money that can help my chil-
dren,” she says. “This is not a business. It is a service.”
But while Parmar may describe it as a reasonable
exchange, experts like Sital Kalantry, a clinical pro-
fessor of law at Cornell Law School who has written
extensively about surrogacy, worry about the lack
of informed consent often involved in commercial
surrogacy, especially given that many of the women
are unable to read the contracts written in English,
and sign them using their thumbprints. Kalantry says
there is a conflict of interest created by the doctor
acting as both the fertility doctor and the surrogate’s
ob-gyn, which she believes means that the health of
the fetus is often prioritized over the health of the sur-
rogate. Like Parmar, most surrogates get C-sections,
Kalantry explains. “Those are more invasive than a
vaginal birth,” she says. “But it’s probably safer for the
fetus, and it’s probably also more convenient for the
doctors. It’s more convenient for the intended par-
ents so that they don’t have to wait around.” (Patel
says she tries to help surrogates deliver vaginally, but
if there is a medical issue or the woman requests it,
they do a C-section. She says her clinic has a C-section
rate of 70%; the national rate is 17.2%.)
Kalantry also takes issue with the convention
of having surrogates stay away from home, though
some say they prefer it in order to avoid the pry-
ing eyes of neighbors and relatives. “I think put-
ting women in a surrogate home is problematic,”
Kalantry says. “It’s almost like a jail-like situa-
tion.” While well- established clinics like Akanksha
do not require surrogates to spend nine months in
the center, they strongly encourage it. Women’s-
rights advocates cite the troubling power dynamics
of wealthy urban doctors asking uneducated rural
women to stay in clinics where they can monitor
them. Meanwhile, experts say conditions in smaller
clinics are considerably worse.
After her first time being a surrogate, Parmar was
able to save some money in a fixed deposit. Now, she
is back at Akanksha, hoping to earn more money to
save for her children’s education and marriage. With
schools closed because of the pandemic, she has
brought her 10-year-old son Satyam; he sits beside
her eating lunch in the room she shares with seven
other surrogates. But Parmar’s stay is different from
her previous one in other ways too.
The first time, Akanksha offered classes in
makeup, sewing and making decorative objects.
This time around, pandemic restrictions mean the
women have no activities to distract them. Parmar
was restless when she first arrived at Akanksha, not
allowed to go beyond the hospital complex except
for family emergencies. By lunchtime on the day we
spoke, she had already washed her clothes and vis-
ited the temple on the hospital’s lawn; the rest of
her day would be spent chatting with the other sur-
rogates and watching television. Soon, the women
would be served coconut water and fruits, a luxury
Parmar could not afford back home.